The Power of the Oral Microbiome in Health

Hi everybody, I'm Dr. Sanda Moldovan, periodontist and nutritionist. Welcome to the Holistic Dentistry Podcast, the show that gives you the tips and tools to detoxify your mouth for a healthier body as we explore together the root cause of disease. Remember, you're not healthy until your mouth is healthy, so take care of it in the most natural way. Hi everyone. Welcome to another episode on the Holistic Dentistry Show, and I am super excited today to talk to Dr. Nami Patel, who is a green dentist in San Francisco. But she incorporated so many different methods in her practice, and I really am excited to discuss how can dentistry, the type of dentistry she does, influences the body and how she got excited about green dentistry. So Dr. Nami Patel, welcome to the show.

Well, I'm so excited to be here and I feel like we may be soul sisters.

Yes. And here, you know, we are from California, but we meet here in beautiful Cannes.

I know, the wonderful scenery and of course your gorgeous smile. So—

Yeah. And we're here for the Biohack Yourself series.

Yes.

The premiere of Shield, which is women's health. And let's talk dentistry though for the next 30 minutes or so.

Let's do it. Let's do it.

So tell me what made you interested in, in green dentistry or integrative dentistry?

Well, the story is a sad one. The reason I started with, I wanted to, you know, I graduated dental school and I wanted to do something that was different. So I went on for interviews. I did not like any of 'em because it was such drill and fill dentistry at the time. This is now 22 years ago. And so I decided I wanted to start my own practice. But I was like, if I'm going to start my own practice, what do I want it to be like? And so one of the most important things for me was eco-sustainability. So I started a green practice. It's called Green Dentistry.

Is it because you are passionate about the environment?

It's because I was passionate about the environment. I also wanted to make sure that the materials that went inside the mouth were biocompatible. So I've never placed a mercury, you know, outside of dental school.

I love it.

Yeah, right.

So— You're crazy enough. Mercury fillings are still being placed in dental school, which is crazy. I know, I know.

It's crazy the fact that they're required to be tested on it. I find it so funny.

So true. So at the time, did you know about like IOMT or no, you just started this?

No, I didn't. And then what happened is I was building my practice and on the day that I was actually supposed to open my practice, the night before midnight, we got a call and I heard my mom screaming and I didn't understand why at the moment. And so she's crying and And then I just heard that my 33-year-old brother who's died of a heart attack. Oh my God. A 33-year-old person dying of a heart attack. Mind you, he had seen an oral maxillofacial surgeon 3 weeks prior, had been to the ER, was complaining of chest pain. They all dismissed him because they said, "Oh, it's acid reflux. See you later. You're 33 years old. There should be nothing wrong with you." So he went on his trip and his system was so stressed out that he ended up having a heart attack in India and he passed. And I, when I heard the news, of course I was grief-stricken, but I knew something was, something was off. There's no reason why a 33-year-old dies of a heart attack. It does not happen very often, especially a young, healthy one, you know, that looks normal.

Mm-hmm.

And so I really started researching and started learning more and more. Of course I come from Ayurveda, so we're all into the natural way of living. I was already into non-toxic chemicals, no mercury and all of that. Then I started learning more and more, and so I've, you know, gone through the Holistic Dentist Association. I've done learnings through the Bale Doneen Institute, which is actually certified to help prevent heart attacks. Bale Doneen Institute. I've done, you know, work through Recode. I've done just so many different works to learn about how the mouth is connected to the rest of the body and what can I do better. In fact, I even went through a 2-year training through Kalish Institute for Functional Medicine so that I can really learn what oxidative stress does to our body and how it controls the HPA axis and how can we actually be able to serve our patients better and start looking at the mouth connected to the body. And that's been my, my passion. And so it's been a long 20 years.

Yes, there's always something.

Lots of You know, lots of learning, but I knew that my pain, I had to turn it into my passion. And I was already passionate about green dentistry and then to become, you know, holistic, biological, functional, biomimetic. And I put all these words together because that's really what I do. I really do all of that together and it doesn't, it's good dentistry.

Yes.

You know, I'm not a labeler. I'm like, I do good solid dentistry. I'm a good solid doctor. And I really look at how can I help the person in front of me? What is it that I can do when I have a woman that's like in her 40s feel, you know, she's like, my biomarkers are fine. My doctors are telling me I'm fine. I've got nothing wrong, you know?

Yeah.

But I feel tired and dead inside. I wanna play with my kids.

So where do you start with that?

You know, I start with that. I usually have 'em go through a series of testing. And so the first thing I always start with is the airway, 'cause that is the foundation. And the reason I do that, and it goes back to my story with my brother, is also if you're not breathing, you're not alive. So I always start with the airway first. That is the most important aspect for me, mainly because again, if you're not breathing, you have 8 minutes.

Yes.

After that, you're gone, right?

I'm glad you're bringing this up with the breathing because I think in dentistry we have this amazing opportunity to really look at the airway. People don't come in for that usually.

No.

They don't even know they're not feeling well because they're not breathing.

They're coming in for a broken tooth.

Yeah.

My tooth chipped again. This crown came off again.

Yes, yes, yes. But I feel with you, like the breath is, is, is going to change their life if we can improve their breath. So tell me more about that. What do you do in your practice to help the breath?

So the first thing I look at is usually I look at their labs because I want to know what's, you know, what's been going on with them. What is up? What may be subclinical that maybe doctors aren't looking at? Again, vitamin D3 is so basic to look at. Vitamin B12 is the next one I look at because we want it under a certain threshold to make the 4 species of bacteria to survive in the gut. Because that's your immune system. So I really start off with looking at the airway. I start looking at the oral microbiome. I start looking at their blood work and of course their dental x-rays, you know. But what the interesting part about all of this is sometimes I'll get a patient, um, who is chronically ill. They either have, you know, cancer or some sort of chronic illness for a long, long, long time and their gums don't bleed. But then when I do the microbiological testing, I'm seeing all these bugs in their mouth, you know.

Yeah.

Yes. And it's fascinating, after I clean them up, they come back like, just like, "Oh my gosh, I feel so good." And I was like, "Really?" That's it.

Just from a dental cleaning.

That's it. And they're, you know, super happy because their bacterial load is decreased, their body's able to focus on regeneration. So it's really exciting to be able to, you know, as simple as that. And then sometimes I have patients who are cancer patients, you know. And they've got cavitations, they've got a mouthful of amalgam that needs to be changed out. They're in chemotherapy and I have to figure out like, listen, I can't be doing this right now. I've got to figure out how we're going to sequence this process so that we can get all the toxins out of your mouth. And also you can finish chemo and you can heal.

Yes, for sure. Let's talk about the oral microbiome for a moment. I love the fact that you do testing as a periodontist. I'm a big fan. Big fan of testing. We need to know what we're treating. Uh, what's your favorite oral microbiome test that you'd like to do?

I, you know, I have used a few. My favorite one right now is still Oral DNA. It's still the gold standard. Yeah, it's still the gold standard. And I really like that because I'm really able to see, um, what it's— I'm looking for the bad stuff. Like, I mean, there's all these— there's Bristol, there's all these other ones. I'll give you a whole bunch of cock— I mean, it's a lot of information. I don't want to call it caca. It's a lot of information, but It's useless for me as a, you know, a medical grade clinician. As a medical grade clinician, I want to know which ones are specifically causing disease. And 99% of the time it's actually bacteria. It's not viruses that are in the gums. It's not parasites that we're looking in the gums unless it's a cavitation. You know, majority of the time we're looking at, you know, these 13 species of bacteria that are related to chronic illnesses. So I usually start with that. I don't like to use antibiotics, so I usually have my patients— I'm a big fan of ozone, so try Exactly.

Yes.

So I love ozones and lasers are my favorite things to use. And so that's what I typically use in the practice to be able to serve the patients. Yeah. And I, you know, and especially with so much antibiotic resistance going around, sometimes I have to use it, but I really try not to because I really don't want to mess up the gut microbiome because it takes at least 6 months to repair that afterwards. And it really, you know, puts the— it's like I fix one problem and I start another.

It's so true. I agree with you, you know, and now my myself practicing for 20 years, I really have rarely have seen the need unless somebody has heart issues already and has, you know, AA, especially high numbers.

Yeah, positive.

Then, okay. But other than that, I don't think it should be go-to. And I think one of the problems with the oral DNA is that, you know, they try to give dentist guideline, but I do believe there should be more training there, what to do with the results.

Right. I agree. I agree. You know, they, they actually bought out a company called 5HRT. HRT. Yeah, it is 5HRT, which gave amazing guidelines as far as what dentists should be able to do. But that information is not available anymore. And that's what I learned from them as well. But as far as, you know, they kind of leave it up to the dentist. I mean, for goodness sake, they even say to use chlorhexidine, which I'm like, oh my goodness.

No, no, no.

Yes, it's toxic. Right, right.

Let's not use it.

And so it's, it's so funny because I wish they did have more, more guidelines for dentists and more of a clear clear-cut structure to be able to help with what we do after the microbiological testing, and especially with adjuncts, you know, being able to give probiotics, being able to, to give that information, especially because it can be data-driven and results-oriented, which is what we're seeking.

Yes, absolutely. So that's one of the things you do is the oral microbiome test. What do you do after that?

Oh, so I go through sources of infection. So, uh, definitely your mercury removal, right? We look at that, we look at failed through canals. I definitely look at cavitations, making sure that they're removed. And, you know, before I start doing all this stuff, the reason I start with the airway and the oral microbiome first is because I want the body to be able— if I'm going to remove mercury, I want the body to be able to process it.

Yes.

Right. I, I don't want to add to that toxic burden the body already has. So if the body's sleeping well, I know it's going to be able to regenerate. If I've got these bacteria out, I know that the body isn't fighting infection, it's actually going to be working much better. So that's where I start off with, and then I go to removing the toxins, because the key with toxins is that we release them, obviously, when we're removing them. And if we're going to release them, we've got to make sure that our body can process it. And so if we want it to be processed, we need to put ourselves in tip-top shape, kind of like before a cavitation. You don't— don't take— cut a piece of bone out and say, peace out, see ya. We want to do a bone healing protocol, right?

Yes, yes.

We want to do it 4 weeks before, 4 weeks after, um, to, to make sure that the patients are going through a good healing, right?

Absolutely.

And especially chronically ill patients, right? We want to make sure they're going to heal well because if they don't, then—

Then they're going to blame the dentist saying they didn't do a good job.

Right. And also, like, we didn't make their job any better. We just gave them more pain.

True.

You know, can you imagine a cavitation not healing well? That is—

Exactly.

Worse than a dry socket.

So, you know. So true. So true. Now, how do you diagnose, uh, you mentioned failed root canals and cavitation. How do you like to—

Oh, you know, CBCT. Um, CBCT is the easiest way to diagnose failed root canals and failed cavitations. And I also like to make sure that I'm looking at people's genetics before I, you know, I give them my recommendations. Not— you can't take out every root canal, you can't take out every cavitation, you can't do everything all at once, right?

Yes.

And so it's really important that things are sequenced properly and done in a way that's safe for the patient. So I usually, yeah, I like to make sure that I know how their bodies are working Also making sure I coordinate with their functional medicine doctors or, you know, medical doctors to make sure that they're getting the proper support that they need as we're going through, for example, mercury removal, making sure they're getting chelated. You know, a lot of times I want to make sure the mold is out.

Yeah, so true.

If the mold is not out, good luck getting the mercury out. So it's like, we'll do what we do and they'll be like, nothing changed, it went worse.

Now let's talk about this. Sequencing? Because I think this, this is an important thing. You know, I, I have some physicians that I work with, they're like, oh no, take everything out at once. I want the body to like just have the shock and heal. And then I have patients that are like, oh my God, this is just too scary. So, so how do you decide like the sequencing? Do you leave it up to the physician? Do you, do you decide?

You know, I always still like to talk to the physician to make sure that I communicate with them like what I'm doing. And you know, hands off, like, or the What's a given is always gonna be oral microbiome and airway. Like, we gotta get that done, 'cause we can't, you know, and that is usually sufficient enough for them to get started with the chemo or whatever treatment that they need. But as far as removal of root canals or amalgams and stuff, I usually wait a little bit longer to make sure that their immune system is better. For example, with cancer patients, like, I, I wanna make sure they're done with chemo, you know, or I do it before they start chemo. So if they're gonna start chemo in 6 weeks, I would make sure that all of that is removed before we start. They go through a chelation process and then they go through chemo because the last thing we want is mercury to bind into porous cells and they're already weakened at that point in time.

Yeah, absolutely. Makes sense. I like the way you think. Let's talk about the airway. What are your different ways that you help people with their breathing and correct their airway?

So with the airway, you know, the first thing I always want to do is make people realize that they're mouth breathers. Kind of like with Harry Potter, stop being a mouth breather.

I love it.

So many people forget that they're mouth breathers, you know? And so it's really important that we want to make sure they start breathing through the nose and making them aware of that is a huge thing. Second thing, making them aware of their sleeping patterns is really big because they never realize how poorly they sleep until, 'cause most people think it's normal not to sleep well, right?

Yes. Do you do the sleep test?

I do. I absolutely do the sleep test. So I want to make sure that I do the sleep test for all my patients and make sure that I'm not diagnosing sleep apnea or anything like that, but I'm just checking if that's the case or not. And then I refer them to their medical doctors. When it comes to treatment, I look at their CBCT and I look at what is the problem. Like, where is the problem? Is it the sinuses? Is it the tongue posture? Or is it the windpipe? Because if it's a simple thing like a tongue tie, you know, let's do that.

Yes. Let's talk about tongue ties because I think people don't realize how many of them go undiagnosed. Oh my God. And if somebody has a tongue tie, what does that do to their breathing?

Well, if somebody has a tongue tie, their tongue is not gonna go to the roof of the palate, and if that's the case, you're gonna snore. Not very sexy, but the snoring is actually the body's alarm bell asking for help, right? So when the tongue is not in the proper place, you can't breathe really well, and especially during a time when you're supposed to be sleeping. Sleep is important because we should be regenerating. Our bodies are designed to regenerate. And if we are not sleeping well, we're not regenerating. That's the first thing that happens. Now, there's some huge concerns with heart attacks and Alzheimer's as well, because when you're not getting enough oxygen or you stop breathing, it puts pressure on your heart. And so when do most heart attacks happen? 10:00 PM and 6:00 AM. What's everyone doing?

Mm-hmm.

You always hear about, did— person went to sleep and never woke up. It's the heart attack that happened. It's the silent killer. When it comes to Alzheimer's, if you can cut off blood flow to your body and then your brain doesn't get blood flow for 10 years, 20 years, 30 years, that's what we call Alzheimer's.

Mm-hmm.

Exactly. Dead brain tissue over— didn't get enough oxygen. And then also when we're getting that interrupted sleep, our brains don't get enough time to poop. So that's why people are irritable or ADHD.

Yes. Yeah. So a lot of conditions, you know, can be helped in the dental office. Right.

For sure. Absolutely.

Just something simple.

Exactly.

So do you use those advancement devices for people?

I do not. I am not a big fan of mandibular advancement because I find that mandibular advancement leads to TMJ problems. So when it leads to TMJ problems, it's not something I want to be a part of. I make sure my biggest thing about patients, and a lot of patients we can treat with myology and really doing myofunctional therapy and tongue tie releases. That's the first place I like to start because it's the easiest. Uh, you know, there's all these articles through Stanford that, you know, just doing tongue exercises has made an increase of 30% in the airway, which is huge, right?

Huge. Yeah.

So I always start with the myology first and then I go to the tongue tie, then I go to appliances if we need, because the key about appliances is you gotta make sure patients wear them.

That's true.

And so if there's something that's gonna do this, it's kind of hard to sleep with. Even night guards. How many patients do we have who have night guards and don't wear them?

Exactly, right?

And it's also a big piece of plastic.

It's so true.

Why would I want to give another big piece of plastic that's leaching in your mouth overnight?

That's so true. And I did a show not that long ago about my microplastics in dentistry. Yes, it's huge. Yeah, and unfortunately, you know, the silicone mouth guards are too soft and chewy, so not everybody can tolerate them. Exactly.

So I feel like dentistry's come a long way, but I'm really still waiting for the day that we can plant a tooth.

Yes, that would be amazing.

Wouldn't that be great?

That would be really great.

I mean, I'm not a big fan of peptides and all this other stuff, but I feel like that's the one thing I would be so into, stem cells.

Yes, that is so true. One day, I think in the near future, we should be able to do something with stem cells for sure.

I would love that. I would love that. I feel like huge steps.

Yes. Can you think of a patient that you've helped through the way you practice dentistry that came to you and, you know, how they ended up on the other side?

Absolutely. Absolutely. I have plenty of fun stories. The recent one I wanna share is actually, since we talked about the oral microbiome, I've actually had a patient, you know, her, she's, I would say 46, 47 hormonal changes starting many, you know, perimenopause. Comes in, she has arthritis and her knuckles swell up and she's like, you know, it's so hard for me to wake up. When I wake up, for me to open my pill box to help me get rid of the pain from my knuckles is so challenging. And, you know, I learned about the mouth being related to the body, so she came into our practice and really all I did was ozone cleaning, cleaning her up really, really, really, really well. Using lasers, and then, you know, 6 weeks later we test her. But the fun part about all of this stuff is that she comes into me, I think it's like 10 days later or something like that. She calls the office and like super excited, and we're not really wondering why she wants to come by. She comes by, like literally runs to me and like gives me the biggest hug because she's like, You know, ever since that day, my knuckles don't swell up.

That's amazing. Does she have a lot of P. gingivalis?

She did, yes. Tons, tons above the line.

Yes.

And CDTF as well. So I was like, okay, you know, let's— she didn't have AA, which was really great, and lots of FN. So it was really nice to be able to see that just change so quick, like within 10 days, you know. And it's so funny because she was like, the next day I woke up and it was feeling really good, but she was like, I didn't think it was true. So she's like, I didn't call you the next day because I knew that was going to come back the next day. She's like, I kept waiting for it to come back. I kept waiting for the swelling to come back. And then she's like, you know, then she's like, I waited a week and then I realized maybe this is for real.

Yes.

So that was really—

I love it. Yes. How many things we can change in terms of health when we work on the mouth?

Oh my God. Yes. Your mouth is the best thing you can invest into. I absolutely believe in it.

Yes. And unfortunately, you know, there's something about the stigma about deep cleanings, you know, I don't have pain, I don't have, you know, why should I do this? Which, you know, but I hope we're convincing the people listening, especially if they have bleeding gums.

Yes.

To go to somebody who can test them with an oral DNA test.

Actually, I was going to say, even if you're not bleeding, you know, and you're over the age of 40, go test yourself because we now know that dry mouth, which happens during menopause, perimenopause, also mouth breathing, which happens because of the plastics in the air and the pollution in the air, and also all these allergies and pollen and God knows what else. We're mouth breathing way, way, way, way more, which creates a dry environment. And also, I would have to say 50% of the population is probably on antidepressants.

Yes.

Again, a massive cause of dry mouth.

Yes.

And that dry mouth is the perfect brewing ground for these pathogens. And these pathogens are the ones that lead to disease. So I would say does not— if you're somebody who is health-focused, the first thing I would do is get tested. I would look in the mouth, I would see what's going on there, what is it telling me, and I would address it, number one, before I went to the medical doctor, quote unquote, because you do need to see them too. But when it comes to dentistry, we need a test.

Absolutely. Absolutely. That's so true. I know we have both customers, patients, and we also have dentists and hygienists listening. So that are interested in integrative aspects of this field. So what advice do you have for them listening? Because I want to encourage as many dentists to think bigger, to think outside the mouth like you do.

I would have to say, if there are dentists and hygienists listening, you know, if this was your body, this was your mouth, this was your loved one, how would you want them to be treated? Would you want the drill and fill and bill? Or would you want somebody that really is concierge care, that really takes the time to dig deeper and really understand what's going on and help them? And I feel like if I had the choice personally, I mean, I would give you a million dollars to bring my brother back. I would give you everything I own to bring my brother back. I would give you anything. And for me, that's— I couldn't find a— if I found a practitioner who You know, the things that I now know, I wish I knew 20 years ago. I wish that I could have helped him.

So, yes. Where should they go first to start learning? Do you think we have a good center for resources that the dentist can go?

So I feel like, so I have courses that I do have made for dentists and hygienists. You can go to drnamipatel.com and there's courses you can purchase and they're on demand, which is really nice and they're kind of light. So, you know, initially when we start thinking of biological dentistry, Holistic Dentistry, it's like a lot of information and way too much. So I've— what I've done is I've done the first step. So you do it on demand, it's pretty easy to hear, you learn about the bacteria, what they do, what the pathophysiology is, and then what you can do to treat it. So that's the first place I would start. There are organizations that you can absolutely learn from. IABDM is one, IOMT, Holistic Dental Association. There's a lot of different—

No, you mentioned IFM.

Yeah. Yes, yes, yes, yes. Yes. And then also, you know, there's people like, you know, Dr. Dom is here. He's a biodentist, fantastic, you know, teaches, you can do his course. I feel like there's a lot of people out there, but the thing is with dentistry, already have full lives and we've gotta learn at our pace and we've gotta find a way to integrate it into our practices because not all our patients are looking for biological dentistry.

Correct.

If you talk to a cosmetic patient about biological dentistry, they're gonna run.

That's true.

Right? So we've gotta figure out a way to have that conversation one-on-one and then also to shift that practice model and make, and also ours, and do it in a pace that's comfortable. So start with the easiest thing, right? Like it's easy to learn about the oral microbiome. Let's start there, you know? Take the test on yourself, read it, let it make sense, simmer on it for 90 days.

Yes.

Right? Then take the next step. I like it. And then take the next step, just like we do with our patients.

Yeah, that's great advice.

Yes.

Anything else, Dr. Nami, that I haven't mentioned that you want to end the show with?

Well, you know, your mouth is your longevity medicine. That is my tagline. It is something that I'm super passionate about, and it's my life's purpose, and I'm so delighted that we're doing this together.

Me too. Thank you so much for being here. This, this was a Very interesting conversation, and I know our listeners got a lot out of this, whether they were patients, whether they were dentists or hygienists. And by the way, if you really like this episode, for those of you listening, please share it with somebody in your family or maybe a friend that you know would benefit from this episode. And until next time, stay healthy. Thank you so much for joining me this week. Please make sure you check out the show notes for any links mentioned in the show. If you like today's show, please invite your friends to listen as well. That would mean a lot to me. Do you have a question you'd like me to answer? Message me on Instagram @drsandamoldovan. This is Dr. Sanda Moldovan, and remember, your mouth is the gateway to your health, so take care of it in the most natural and best way possible.